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Insurance Certificates 2018/19 LH Productions!�a DATE(MM/DD/YYYY) A Ill 40" CERTIFICATE OF LIABILITY INSURANCE ` 10/12/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER (CONTACT NAME' Jason Hobbs StateFarm JASON N. HOBBS - LIC#OD42989 PAHO No. E,,, (714)848-3276 ' FAX NoI. (714)848-3262 ® � r STATE FARM INSURANCE AADDRESS! 18351 BEACH BLVD STE B INSURER(S) AFFORDING COVERAGE NAIC# HUNTINGTON BEACH CA, 92648 INSURER A: State Farm General Insurance Company 25151 INSURED INSURER B• State Farm Mutual Automobile Insurance Company 25178 HIGHT, LAFAYETTE INSURERC• DBA LH-PRODUCTIONS INSURER D : 1453 VIRGIN IA AVE STE E INSURER E : BALDWIN PARK CA 91706-5870 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SU&R POLICY EFF POLICY EXP LTR INSD WVf' POLICY NUMBER _IMM/DD/YYYY) (MMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ®OCCUR DAM&zn i u mrr4 itu 300,000 PREMISES (Ea accurrunce] $ MED EXP (Any one person) $ 5,000 A 92-EN-D494-5 06/28/2018 06/28/2019 PERSONAL s ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PROECT- LOC PRODUCTS - COMPIOP AGG `$ 4,000,000 J OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident ANY AUTO 586 2865-A13-75 07/13/2018 01/13/2019 BODILY INJURY (Per person) $ B OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS ONLY AUTOS HIRED _ NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY fPer accidenl) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEL) RETENTION $ $ WORKERS COMPENSATION PER STATUTE I AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED ❑ N / A (Mandatory in NH) E,L..DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF LA QUINTA, IT'S OFFICERS, OFFICIALS, AGENTS ACCORDANCE WITH THE POLICY PROVISIONS. EMPLOYEES AND VOLUNTEERS AUTHORIZED REPRESENTATIVE 78495 CALLE TAMPICO 5G�H:Gi/LC� �� LA QUINTA CA 92253 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849 12 03-16-2016 Policy No. 92 END494 5 3001—FB92 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 END494 5 Named Insured: HIGHT, LAFAYETTE DBA LH—PRODUCTIONS 1453 VIRGINIA AVE STE E BALDWIN PARK CA 91706-5870 Name And Address Of Additional Insured Person Or Organization: CITY OF LA QUINTA ITS OFFICERS OFFICIALS EMPLOYEES AGENTS AND VOLUNTEERS 78495 CALLE TAMPICO LA QUINTA CA 92253 2839 1. SECTION II — WHO IS AN INSURED of b. If coverage provided to the additional in - SECTION II — LIABILITY is amended to in- sured is required by a contract or agree- clude, as an additional insured, any person or ment, the insurance provided to the organization shown in the Schedule, but only additional insured will not be broader than with respect to liability for "bodily injury", "property "personal that which you are required by the contract damage", or and adverbs-that agreement to provide for such addition- ing injurycaused, In whole or in part, by: al insured; and a. Ongoing Operations c. If the contract or agreement between you (1) Your acts or omissions; or and the additional insured is governed by (2) The acts or omissions of those acting California Civil Code Section 2782 or on your behalf; 2782.05, the insurance provided to the additional insured is the lesser of that in the performance of your ongoing opera- which: tions for that additional insured; or (1) Is allowed for the satisfaction of a de- b. Products — Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional fornia Civil Code Section 2782 or insured and included in the "products- 2782.05 for your sole liability; or completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the agreement to provide for such addi- following: tional insured. a. The insurance afforded to the additional We have no duty to defend or indemnify the insured only applies to the extent permit- additional insured under this endorsement un- ted by law; til a claim or "suit" is tendered to us. p, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc, with its permission CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: CM P-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless c f any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. (1) How, when and where the "occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CM P-4786 1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLAHATION5 AMtr4UtU JUN ;eb ;eU1 b 75085 3925 Policy Number 92-EN-D494-5 Policy Period Effective Date Expiration Date M-23-3001-FB92 F Z 12 Months JUN 28 2018 JUN 28 2019 004144 3123 The poll y period begins and ends at12:01 am standard Addl Insured -Section II Only time att�ie premises location. CITY OF LA QUINTA ITS OFFICERS OFFICIALS EMPLOYEES AGENTS AND VOLUNTEERS 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 Named Insured HIGHT, LAFAYETTE DBA LH-PRODUCTIONS 1453 VIRGINIA AVE STE E BALDWIN PARK CA 91706-5870 Home Product Sales Policy Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Li enholder written notice in compliance with the policy provisions or as required bv law. Entity: Individual Reason for Declarations: Your policy is amended JUN 28 2018 ADDL INSURED INFORMATION CHANGED PREMIUM ADJUSTMENT FORM CMP-4788.1 CHANGED Endorsement Premium None Discounts Applied: Years in Business Protective Devices Claim Record Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission 040498 290 Al Continued on Reverse Side of Page N Page 1 of 6 uiwi B A 9 m.m.9nn rnin9mr. DECLARATIONS (CONTINUED) Home Product Sales Policy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Number Described Premises Coveragge A - Buildings 001 1453 VIRGINIA AVE STE E No Coverage BALDWIN PARK CA 91706-5870 Limit of Insurance* Seasonal Increase - Coverage B - Business Business Personal Personal Property Property $ 129,600 25% 4s of the effective data of this policy, the Li mil of Insurance as shown includes any increase in the limit due to Inflation Coverage. ,gCTION I - INFLATION COVERAGE IND X(ESI Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 249.0 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 040498 Continued on Next Page Page 2 of 6 DECLARATIONS (CONTINUED) Home Product Sales Policyy for CITY OF LA OUINTA ITS OFFICERS Policy Number 92-EN-D494-5 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 040499 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Home Product Sales Policy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those'premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY Included $5,000 $2,500 $25,000 $10,000 30 Days $2,500 $5,000 $10,000 $5,000 Included The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 040499 Continued on Next Page Page 4 of 6 J DECLARATIONS (CONTINUED) Home Product Sales Policy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4101 Businessowners Coverage Form CMP-4788.1 *Addl Insd Mgrs Lessor of Prem FE-6999.2 Terrorism Insurance Cov Notice CMP-4705.1 Loss of Income & Extra Expense CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4698 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm CMP-4786.1 Addl Insd Owners Lessee Sched CMP-4795.1 Addl Insd Designated Premises CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 040500 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Home Product Sales Polio for CITY OF LA QUINTA ITS OFFICERS Policy Number 92- N-D494-5 " New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois, *�, )TL Y..-tL 4OW4- Cm/# Secretary President IMPORTANT NOTICE: California law requires us to provide you with Information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact Information are provided on the front of this document. Another option Is to reach out by mail or phone directly to: State Farm Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (1-800-782.8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Ancjp Ws, CA 9uu13 Phoiu� � I•ti�iU-42I-rlELfs (4357) or visit �vav��.insEitai�4�.sa.c�ovfa I-�vnsin�zers Prepared JUL 18 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 040500 290 Page 6 of 6 N A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTAL;HIN(a UEC:LARATIONS , F? x 805,33T 75085 3925 Policy Number 92-EN-D494-5 Policy Period Effective Date Expiration Date M-23-3001-FB92 F Z 12 Months JUN 28 2018 JUN 282019 The poll y period begins and ends at 12:01 am standard Named Insured time Ae premises location. HIGHT, LAFAYETTE DBA LH—PRODUCTIONS 1453 VIRGINIA AVE STE E BALDWIN PARK CA 91706-5870 ATTACHING INLAND MARINE Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared Pre © 18 2018 Copyright, State Farm Mutual Automobile Insurance Company, 2008 JULFD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 040501 536-666 o.2 65-31-2011 (03232c ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8745 Prepared JUL 18 2018 FD-6007 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE $ 25,000 25,000 DEDUCTIBLE AMOUNT S 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY ® Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 040501 530-686 a.2 05-31-2011 Iolyd233cl Declaration of Sole Proprietor DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO LH Productions I declare for the purpose of inducing the City of La Quinta to go forward with any contracts awarded to LH Productions as follows: I am the authorized representative of LH Productions, an independent contractor for the purposes of the California Workers' Compensation and Labor laws. This organization will hire no employees other than the parents, spouses, or children of its board members for work required for any bid or contract awarded to LH Productions. All worked required will be performed personally and solely by me, other board members of the organization, their parents, spouses or children, or persons who perform voluntary service without pay to the organization. If, however, the organization shall ever hire employees to perform this contract or any portion thereof, the organization shall obtain Workers' Compensation Insurance and provide proof of Workers' Compensation Insurance coverage to the City of La Quinta. If the organization shall ever hire a subcontractor to perform this contract or any portion thereof, and the subcontractor has employees, then the organization shall require its subcontractor to obtain Workers' Compensation Insurance Coverage, or the organization shall obtain Workers' Compensation Coverage for that subcontractor's employees. This document constitutes a declaration by the organization against its financial interest, relative to any claims it should assert under the California Workers' Compensation and/or Labor laws against City of La Quinta relating to any bid or contract awarded to LH Productions. The organization will defend, indemnify and hold harmless the City of La Quinta from any and all claims and liability, including Workers' Compensation claims and liability that may be asserted or established by any party in the event the organization hires an employee in violation of this addendum, and the organization will further indemnify the City of La Quinta for all damages the City of La Quinta thereby suffers. I agree that these declarations shall constitute an addendum to any bid or contracts awarded to LH Productions. August 22, 2018 Date Authorized Representative StateeFFarm STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED SEP 17 2018 PO P34xrdsan853 Ric t,9R 75085-3925 a M-23-3001-FB92 F Z 003546 3123 Addl Insured -Section II Only CITY OF LA QUINTA ITS OFFICERS OFFICIALS EMPLOYEES AGENTS AND VOLUNTEERS 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 Home Product Sales Policy Policy Number 92-E N-D494-5 Policy Period Effective Date Expiration Date 12 Months JUN 28 2018 J pN 28 2019 The poll y period begins and ends at 12:01 am standard time att�ie premises location. Named Insured HIGHT, LAFAYETTE DBA LH-PRODUCTIONS 1453 VIRGINIA AVE STE E BALDWIN PARK CA 91706-5870 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended SEP 17 2018 ADDITIONAL INSURED ADDED LOCATION ADDRESS CHANGED FORM CMP-4795.1 ADDED Endorsement Premium Increase Discounts Applied: Years in Business Protective Devices Claim Record $ 64.00 Prepared OCT 17 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 032520 290 Al Continued on Reverse Side of Page N Page 1 of 6 eqn-eAS. 9 ne_11_9n11 10PMM DECLARATIONS (CONTINUED) Home Product Sales Policy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 E TI N I - PRQPERTY LE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 1453 VIRGINIA AVE STE E No Coverage $ 129,600 25% BALDWIN PARK CA 91706-5870 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) _- Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: N/A 249.0 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared OCT 17 2018 ® Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 032520 Continued on Next Page Page 2 of 6 StateFarm A. DECLARATIONS (CONTINUED) Home Product Sales Policy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared OCT 17 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 032521 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Home Product Sales Polic for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-_N-D494-5 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Personal Property Off Premises $25,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $5,000 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included VE A - LIMIT OF IN RAN E PER POLICY - The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown In these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared OCT 17 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 032521 Continued on Next Page Page 4 of 6 ' StateFarm DECLARATIONS (CONTINUED) Home Product Sales Policyy for CITY OF LA QUINTA ITS OFFICERS Policy Number 92-EN-D494-5 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4101 Businessowners Coverage Form CMP-4795.1 *Addl Insd Designated Premises CMP-4787 *Waiver of Trans Rgt of Recov FE-6999.2 Terrorism Insurance Cov Notice CMP-4705.1 Loss of Income & Extra Expense CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4698 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4786.1 Addl Insd Owners Lessee Sched FD-6007 Inland Marine Attach Dec Prepared OCT 17 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission 032522 290 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Home Product Sales PoI for CITY OF LA QUINTA ITS OFFICERS Policy Number 92- N-D494-5 NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. " New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Sr�cretry President IMPORTANT NOTICE: California law requires us to provide you with Information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: Slate Farm' Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA wo i 3 Phone # 1-800-927-HELP (4357) or visit www.insurance.ca.govf0l-consumers Prepared OCT 17 2018 C M P-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 032522 290 N Page 6 of 6